Identifying and Managing Allergies in Children
Allergies can pose challenges while eating, exploring new environments and even going outside. Most of the time for adults, controlling allergies can be easy. However, this may not be the case for younger children as they are still growing, developing, and being exposed to new things that might not already be identified as a risk for them.
I asked Melissa Conniff, RD, Kate Macdonald, RN, and Gemmy Au, Kidco Kitchen Operations Manager a few questions on the background of allergies, what to look for, and how allergies at Kids & Company are handled.
Are allergies heredity? How often are allergies caused by genetics?
Melissa: Genes may play a role in the development of allergies. The term atopy is used to define the genetic predisposition of a person to developing an allergic reaction, including asthma, eczema, allergic rhinitis (hay fever) and food allergies.
Although the definition of an infant that is at high risk for developing allergies continues to evolve, the latest article by the Canadian Paediatric Society (see here) defines an infant at high risk of developing an allergy by “…having a personal history of atopy, including eczema, or having a first-degree relative with atopy (e.g., eczema, food allergy, allergic rhinitis, or asthma).”
In simple terms, a person is at higher risk for developing allergies if they have eczema or if their biological parents or sibling(s) have allergies. The risk increases if both parents have allergies.
Kate: A child of parents with allergies is predisposed to having allergies, but heredity does not control what allergens the individual will be allergic to. For example if one or both parents are allergic to horses there is a high likelihood that the child will have allergies, but it may be an allergy to something different.
What are signs or symptoms of allergies?
Melissa: Allergies show up when our body thinks an item is harmful and the body reacts by showing different symptoms. The item that the body identifies as harmful is called an allergen.
There are two immune mechanisms of allergies: IgE mediated and non-IgE mediated allergies.
Immunoglobulin E (IgE) mediated reactions are caused by the body’s immune system making antibodies called Immunoglobulin (IgE) antibodies that react to the allergen.
Non-IgE mediated reactions are caused by other parts of the body reacting to the allergen. IgE antibodies are not produced.
A person can have both IgE and non-IgE food allergies.
If a person has a reaction that is IgE mediated, the symptoms will appear within minutes and up to three hours after they are exposed to the allergen. The symptoms for IgE mediated reactions are typically hives, swelling, itchiness, trouble breathing, chest pain, trouble swallowing, stomach pain, feeling light headed or feeling like something terrible is going to happen.
Symptoms can appear to be mild or severe. Take all allergies symptoms seriously as they can develop into an anaphylaxis reaction. Anaphylaxis is a life-threatening allergic reaction that needs immediate treatment.
If it is a non-IgE mediated allergy, the symptoms typically appear later, from 4 hours to 72 hours after exposure to the allergen. The symptoms of a non-IgE mediated allergy usually involve the gastrointestinal tract including vomiting and diarrhea.
What are the most common allergies?
- Food allergies affect an estimated 2%-10% of the population
- Tree Nuts, Peanuts, Milk, wheat, eggs, soy, Fish and Shellfish are the most common foods related allergies.
- Peanuts are actually a legume not a tree nut, but the protein in peanuts are similar in structure to tree nuts. So often children who are allergic to peanuts can also be allergic to tree nuts such as walnuts, almonds, hazelnuts, macadamia nuts, pistachios, pecan, cashews and Brazil nuts.
- Dust Mites
- Insect allergy
When should parents start introducing foods to children to prevent allergies?
Melissa: In January 2019, The Canadian Paediatric Society (CPS) released a document communicating the most up to date practices around allergen introduction. The general consensus on introduction of allergens is as follows:
If your child is at high risk for developing allergies, introduce common allergenic foods around 4 to 6 months, but not before. The child must be developmentally ready to receive solids. If you are unsure about when this is, talk to your primary care doctor.
If your child is not at high risk, introduce these foods around 6 months.
In both cases, if a food is being tolerated well, continue to offer it 2-3 times a week to maintain tolerance. Sometimes peanut butter is offered once and checked off the list if there is no reaction, then it doesn’t get offered again for weeks. It is recommended to continue to offer all foods a few times a week.
If a mother is breastfeeding, this should be promoted and supported up to 2 years of age and beyond. If an infant or toddler has an allergic reaction to a certain food, a mother may need to alter her diet to continue breastfeeding. The mother can contact a Registered Dietitian to help them ensure they are getting the nutrients they need.
For more information on allergy prevention, you can find the full CPS document here.
What precautions and steps should be taken to help children with allergies?
Melissa: If a parent suspects that their child has an allergy, they can speak to their primary care doctor to see what the next steps are. This may include a referral to an allergist, a pediatrician or another specialist. Once the doctor has determined what the child is allergic to, the parent may want to contact a Registered Dietitian to review the child’s diet. A Registered Dietitian can provide ideas for replacement items and ensure the child is getting the necessary nutrients for optimal growth.
When looking for information online, make sure it is from a credible source. The following are reputable sites to find information:
Kate: If a child has a confirmed allergy it is important for parents to avoid that allergen. Educating family, teachers and caregivers about how to avoid the allergy, proper hand washing, and how to treat it is crucial.
Reading the food labels is important to ensure that the allergen is not contained as an ingredient. Ingredients can often change and maybe found in food you would not think may contain that food allergen. Also look at advisory statements on the packaging as there may be some cross contamination, for example “may contain nuts” or “processed in a facility that also processes nuts”.
Hand washing is fundamental for anyone that is preparing the child’s food. Hand washing must be done with soap and water before touching the food. The child’s hands must also be washed before eating. Use hand- cleaning wipes if soap and water are not available. Do not use hand sanitizer gels or spray as they do not get rid of the allergen, they just kill any germs.
Eating out is possible but there are a few things that you can do to ensure that your child’s meal is prepared safety. Speak to the waiter or chef and do not be afraid to stress how severe your child’s allergy is. Often visiting a restaurant NOT during peak times will allow the staff more time to prepare the food.
Epinephrine- if your child has a serious food allergy (anaphylaxis) your doctor will want them to carry an epinephrine auto injector. This is a prescribed medication that once injected will work quickly to decrease the severe life-threatening allergy symptoms. It is important for everyone including the child, their parents, caregivers, and teachers to be aware of where the epinephrine is kept and how to administer it.
Can allergies be outgrown?
Melissa: Yes, many children that are allergic to milk, soy and egg can tolerate these foods by the time they are 3.
In the case of peanuts, only 20% of children typically outgrow this allergy and the percentage is even lower if the child has a tree nut allergy. Fish and shellfish also have lower tolerance rates as children get older.
Kate: The biggest factor that determines whether a child will grow out of a food allergy is which type of food that they are allergic to. Food allergies that children are most likely to grow out of are: milk, egg, and soy. Tree nuts, peanuts and shellfish allergies are often lifelong allergies.
How is it that allergies can be developed later on in life?
Melissa: It is currently unclear why some adults start having a reaction to a food that they have eaten their whole life. The most common foods that adults are allergic to are peanuts, fish, shellfish and treenuts.
Adult food allergies may be triggered by one of the following situations:
- An adult is allergic to an environmental airborne allergen (also called an aeroallergen) and they react to a food because there are components in the food (antigens) that are structurally similar to the airborne allergen. This is also called Oral Allergy Syndrome.
Examples of this are:
- If you are allergic to birch pollen, you may become allergic to the rosaceae family of fruits (including apples, peaches, pears, raspberries and strawberries)
- If you are allergic to ragweed, you may become allergic to melons.
- An adult is allergic to a material that comes in contact with their skin that has similar structures in food.
An example of this is:
- If you have an allergy to latex, you may become allergic to bananas or other fruit and vegetables.
- If you are an adult and you have concerns that you may have developed an allergy, talk to your primary care doctor.
How does the Kidco Kitchen at Kids & Company deal with food allergies when preparing and serving food?
Gemmy: Each child’s allergies/restrictions are specified on a form so that our chefs are able to provide the proper substitutions. We understand there are complexities to a child’s allergies and include different severity levels so that parents can be as specific as possible. We want to children to be able to have as much as possible – so we always differentiate for example Dairy allergies – i.e. Can they have whole dairy? Can they have dairy baked in?
Substitutions are created separately from the main meal so they do not cross contaminate. Children who the same allergies are grouped together so substitutions can be created in the same batch. Allergy lists are posted in the kitchen so chefs are fully aware of each child’s attendance and allergy/restriction and all meals are labeled with the child’s name, allergy and substitution.
What types of food are served to children who have allergies?
Gemmy: We strive to make allergy substitutions as similar to the main meal as possible. For example, if we are making a meal with chicken for a vegetarian child, we will use all of the same ingredients and replace the chicken with bean or a soy protein. For children who have dairy or egg allergies, our chefs will use different recipes that are allergy free that are just as delicious. Often times they can’t even taste the difference!
If the child has multiple allergies, our chefs create simple items with minimal ingredients – either way it will still be healthy and delicious.
How are teachers and caregivers informed about allergies when new children join the centre?
Gemmy: Parents fill out an allergy form and it is added into the centre’s main database. It is signed off by the child’s parents and updated as the child’s allergy changes. Their information is then posted in their classroom and kitchens – children with anaphylactic allergies have their photos prominently up on the wall as a precaution so all teachers and staff in the room can react quickly if they encounter an allergic reaction.
How does Kids & Company ensure children with allergies are protected?
Gemmy: Parents should always test their children for allergies prior to enrollment, and should always try foods at home prior to having them try food at the centres. This ensures that the child is safe in our care! Children should be going for allergy tests every so often as they can shift.
The teachers are familiar with the children with all the allergies and the menu and full ingredient list is available for the staff for reference in the classroom.
The teacher will often sit between the child with an allergy and have them at the end of the table so that they do not come in contact with the regular meal.
Food is always checked by the kitchen, the kitchen assistant, and the teachers before being served to the children.
Children with anaphylactic allergies also have epi-pens on site.
ABOUT OUR CONTRIBUTORS:
Melissa Conniff, RD, MBA, is the owner of Calgary Family Nutrition, a team of Registered Dietitians helping families nourish their bodies with real food.
Kate Macdonald, RN, is a Registered Nurse, Lactation Counselor, and Sleep Coach working with families in Calgary as part of The Mama Coach.
Gemmy Au is the Kidco Kitchen Operations Manager at the Kids & Company head office.
Carina Ho is the Sales and Marketing Administrative Coordinator at Kids & Company. Growing up in Markham, Carina is the youngest of three children. She loves spending time with her friends and family and playing with her nephew! You can reach her at firstname.lastname@example.org.